Nursing Elites

1. A client is admitted with the diagnosis of pulmonary embolism. While taking a history, the client tells the nurse he was admitted for the same thing twice before, the last time just 3 months ago. The nurse would anticipate the healthcare provider ordering:

• A. Pulmonary embolectomy
• B. Vena caval interruption
• C. Increasing the coumadin therapy to achieve an INR of 3-4
• D. Thrombolytic therapy

Correct answer: B

Rationale: In the case of a client with a history of recurrent pulmonary embolism or contraindications to heparin, vena caval interruption may be necessary. Vena caval interruption involves placing a filter device in the inferior vena cava to prevent clots from traveling to the pulmonary circulation. Pulmonary embolectomy is a surgical procedure to remove a clot from the pulmonary artery, which is usually considered in severe or life-threatening cases. Increasing coumadin therapy to achieve a higher INR may be an option but vena caval interruption would be more appropriate in this scenario. Thrombolytic therapy is used in acute cases of pulmonary embolism to dissolve the clot rapidly, but in a recurrent case with contraindications to anticoagulants, vena caval interruption would be a preferred intervention.

2. A client diagnosed with schizophrenia is slow to respond and appears to be listening to unseen others. Which medication should a nurse expect a physician to order to address this type of symptom?

• A. Haloperidol (Haldol) to address the negative symptom
• B. Clonazepam (Klonopin) to address the positive symptom
• C. Risperidone (Risperdal) to address the positive symptom
• D. Clozapine (Clozaril) to address the negative symptom

Correct answer: C

Rationale: The correct medication to address the symptom described, where the client is slow to respond and appears to be listening to unseen others, is Risperidone (Risperdal). Risperidone is an atypical antipsychotic that is commonly used to manage positive symptoms of schizophrenia. Positive symptoms can include hallucinations, delusions, and disorganized thinking. Haloperidol (Haldol) and Clozapine (Clozaril) are typically used for addressing negative symptoms, such as lack of motivation or social withdrawal. Clonazepam (Klonopin) is a benzodiazepine primarily used for anxiety disorders and seizures, not for addressing symptoms of schizophrenia.

3. What action by the nurse will be most effective in decreasing the spread of pertussis in a community setting?

• A. Providing supportive care to patients diagnosed with pertussis
• B. Teaching family members about the importance of careful handwashing
• C. Teaching patients about the necessity of adult pertussis immunizations
• D. Encouraging patients to complete the prescribed course of antibiotics

Correct answer: C

Rationale: The most effective action by the nurse to decrease the spread of pertussis in a community setting is to teach patients about the necessity of adult pertussis immunizations. The increased rate of pertussis in adults is often attributed to waning immunity after childhood immunization. Immunization is highly effective in protecting communities from infectious diseases. While teaching about handwashing is important for overall infection control, pertussis is primarily spread through respiratory droplets and contact with secretions. Providing supportive care does not significantly impact the disease course or transmission risk. Encouraging completion of antibiotics may help reduce transmission, but patients likely have already spread the disease by the time the diagnosis is made. Therefore, the emphasis should be on prevention through immunization to reduce the spread of pertussis.

4. Employee health test results reveal a tuberculosis (TB) skin test of 16-mm induration and a negative chest x-ray for a staff nurse working on the pulmonary unit. The nurse has no symptoms of TB. Which information should the occupational health nurse plan to teach the staff nurse?

• A. Standard four-drug therapy for TB
• B. Need for annual repeat TB skin testing
• C. Use and side effects of isoniazid (INH)
• D. Bacille Calmette-Gurin (BCG) vaccine

Correct answer: C

Rationale: The nurse is considered to have a latent TB infection and should be treated with INH daily for 6 to 9 months. The four-drug therapy would be appropriate if the nurse had active TB. TB skin testing is not done for individuals who have already had a positive skin test. BCG vaccine is not used in the United States for TB and would not be helpful for this individual, who already has a TB infection.

5. Which of the following is an example of whistle-blowing?

• A. A nurse contacts administration about a colleague who takes supplies to use for a mission trip
• B. A client sues a nurse because she failed to call the physician about his wound infection
• C. A nursing assistant calls for help when a client falls out of bed
• D. A client developed a sacral pressure ulcer when he was not turned in bed for over four hours

Correct answer: A

Rationale: Whistle-blowing involves notifying administration or a supervisor about unethical or illegal activities. In this scenario, the nurse reporting a colleague taking supplies for personal use is an example of whistle-blowing as it involves reporting behavior that is dishonest and potentially harmful. Choices B, C, and D do not represent whistle-blowing. Choice B involves a legal action by a client against a nurse, choice C is a situation where immediate care is provided, and choice D is a case of neglect that should have been prevented.

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